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Massage Table Ergonomics: An overlooked factor in career longevityWorking smart is the key to sustaining your career. Repetitive use injuries are the number one reason massage therapists are forced to give up their careers. The vast majority of these injuries are avoidable with the practice of good body mechanics, a vigorous self-care program and the wise choice of ergonomically sound equipment. Since 1998, massage therapist Laura Pfeiff of Here's the Rub in Warminster, PA has been selling equipment. She says, "the massage table is the tool upon which the practitioner's livelihood is dependent … it is one of their biggest and most important investments because it affects the longevity or brevity of their career." A table is not ergonomic simply because the client is properly positioned. Making sure a client is not too high, low or too far away is only a beginning. There are four other criteria for a table to be considered "ergonomically sound". Containing movement: A table should be a stable platform that contains movement. If, a table moves when the therapist does a stroke, that energy is wasted. We push on a client's muscle to affect the soft tissue, not flex the tabletop. When rocking a client side-to-side for shoulder mobilization, the body should move, not the table. Just as it's harder to walk on sand shifting beneath your feet, so is it harder to do massage when the table flexes or sways excessively. Limiting movement in a table provides a solid and stable feel that reflects other table characteristics, namely quality and safety. For clients, a stable table increases the sense of security and enhances their ability to "let go". A relaxed client is easier to work on and benefits more from a therapy session than one who remains tense. Limiting movement, with superior joinery, premium materials and quality craftsmanship, is also the surest path to silent performance, another quality that helps clients relax. Three-dimensional positioning: There are no straight lines in the human body. So, a flat table imposes stress on a client. A flat table accommodates length and width, but not the dimension of depth. Consequently, clients can experience low back pain, pressure on sensitive breast tissue, compression of hip or shoulder joints, and other stresses. Three-dimensional positioning considers the client's musculoskeletal relationships with the intent to relieve pressure on joints, nerves and muscles. For instance, a face rest that tilts establishes anterior cervical flexion, lengthening the posterior neck muscles. An adjustable arm rest shelf supports the arms without bearing weight, preventing anterior shoulder rotation, and shortening the muscles of the upper back (making them more pliable). Another means for affecting musculoskeletal relationships is through use of bolsters, a tool like the bodyCushion, or an option like breast recesses. Bolsters can shorten muscles and relieve pressure, but with the exception of use under hinge joints, they can create joint compression elsewhere. For instance, elevating the upper thoracic area can cause vertebral compression and muscle strain in the low back. The bodyCushion and breast recess options are "whole body" approaches because they utilize depressions (or cavities), not just elevation, to affect positioning. On flat tables the prone torso elevates, shoulders round forward and the scapula rotate laterally. These movements pull the rhomboids taut, making them harder to work and contributing to fatigue. With breast recesses, the chest sinks in, shoulders come back, and the rhomboids, lats and trapezius muscles are more pliable and easier to work. For therapists working with a whole body approach to positioning, clients will be positioned such that muscles are shortened and more pliable. The resulting decreased angle of the lordotic curve in the lumbar spine relieves low back compression. This neutral positioning of the spine invites the "relaxation response" in ways that a flat table cannot. Ease of use: Stepping in closer to clients and avoiding excessive reaching is a sure way to improve ergonomics. The closer a therapist stands to the client, the closer to perpendicular becomes the angle at which their arms can work. As a result, the transfer of energy becomes more direct, from the legs, through the back and shoulders, down through arms, and to the hands. Many therapists know the ergonomic value of standing in closer, yet they're concerned that the tables be wide enough to accommodate clients' arms comfortably. One option is to purchase a table that is relatively narrow and add a pair of side arm extensions to provide additional width for the client's arms. This provides a best of both worlds solution: a table width that optimizes ergonomics for the therapist and comfort for the client. There are several tables with contoured tops on the market. These are narrower at the midpoint of the table and allow a therapist to step in close and work almost directly over the client. These tables are wider at the point where the client' arms rest. There is often a weight savings with tables of this design. Ease of transport: If you have a room dedicated to massage, you need not concern yourself with the ease of set up or transport. If you do a lot of outcall treatments, then you may wish to invest in a table cart that can go up and down stairs. Few tables are light enough to be a joy to carry and a cart enables you to choose the most solid and comfortable table available and still have mobility. The temptation to purchase a super light table should be tempered against the consequent loss of stability and comfort. By being mindful of body mechanics and using ergonomic equipment wisely, a therapist can sustain a healthy massage therapy practice for decades.
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